AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025130073
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ORIGINAL RESEARCH ARTICLE

Influencing factors of chemotherapy-related cognitive impairment in patients with breast cancer

Ying Zhang1† ,  Shuhan Wu1† ,  Yunmiao Ma2 ,  Shuyang Chang1 ,  Jianhui Li1 ,  Bo Tian3 ,  Nan Jiang1 ,  Liping Yang1 ,  Kenian Pan3 ,  Xulong Zhu1,3*
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1 Department of Surgical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
2 Department of Medical Oncology, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
3 Department of Integrated Traditional Chinese and Western Clinical Medicine, Graduate School, Shaanxi University of Chinese Medicine, Xixian New Area, Shaanxi, China
†These authors contributed equally to this work.
EJMO, 025130073 https://doi.org/10.36922/EJMO025130073
Received: 27 March 2025 | Revised: 26 April 2025 | Accepted: 8 May 2025 | Published online: 3 June 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: The chemotherapy-related cognitive impairment is common, but the influencing factors and effective intervention measures are not well known. Objective: To investigate the changes of cognitive function in breast cancer patients before and after chemotherapy, identify the influencing factors of cognitive function in chemotherapy patients, and investigate whether there is a mediating effect among multiple factors. Finally, an intervention was implemented for patients experiencing cognitive dysfunction to evaluate its effects on cognitive function. Methods: Using the convenience sampling method, we recruited 380 breast cancer chemotherapy patients at three tertiary hospitals in Xi’an from October 2018 to May 2019. The Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function scale, the Hamilton Anxiety Scale, the Hamilton Depression Scale, and the social support rating scale were used to evaluate the cognitive function of breast cancer patients during chemotherapy, and analyze the influencing factors of cognitive function. Results: The incidence of chemotherapy-related cognitive dysfunction in breast cancer patients was 19.74% (75/380). The results of the univariate analysis showed that the education level, medical expense payment method, family history of breast cancer, disease stage, and presence of comorbidities could impact cognitive functioning in breast cancer patients receiving chemotherapy (p<0.05). Correlation analysis revealed that there was a negative correlation among cognitive function and anxiety and depression (p<0.01), while a positive correlation with social support (p<0.05). Furthermore, multivariate stepwise regression analysis showed that the education level, medical expense payment method, disease stage, depression, and social support were independent influencing factors of cognitive function in breast cancer patients receiving chemotherapy and that depressive symptoms had a mediating effect in the relationship between social support and cognitive function. Cognitive has been shown to have a positive impact on cognitive function. Conclusion: Cognitive dysfunction in breast cancer patients receiving chemotherapy is a multifactorial condition that requires rigorous educational and social support interventions for improvements of patient outcomes.

Keywords
Breast cancer
Chemotherapy
Chemotherapy-related cognitive impairment
Funding
This research was funded by the Beijing Sisco Clinical Oncology Research Fund (grant number Y-L2020-0013), the Shaanxi Clinical Medical Research Center for Breast Diseases (grant number 2024SF-LCZX-08), the Natural Science Basic Research Program of Shaanxi Province (grant number 2023-JC-YB-345), Shaanxi Provincial People’s Hospital Elite Talent Project (grant number 2022-JY46), and the Shaanxi Provincial People’s Hospital incubation fund project (grant number 2022YJY-57).
Conflict of interest
The authors declare no conflicts of interest.
References
  1. WHO. Latest Global Cancer Data: Cancer Burden Rises to 19.3 Million New Cases and 10.0 Million Cancer Deaths in 2022 Questions and Answers (Q and A). Switzerland: WHO; 2024.

 

  1. Yang S, Zheng L, Sun Y, Li Z. Effect of network-based positive psychological nursing model combined with elemene injection on negative emotions, immune function and quality of life in lung cancer patients undergoing chemotherapy in the era of big data. Front Public Health. 2022;10:897535. doi: 10.3389/fpubh.2022.897535

 

  1. Országhová Z, Mego M, Chovanec M. Long-term cognitive dysfunction in cancer survivors. Front Mol Biosci. 2021;8:770413. doi: 10.3389/fmolb.2021.770413

 

  1. Lange M, Joly F, Vardy J, et al. Cancer-related cognitive impairment: An update on state of the art, detection, and management strategies in cancer survivors. Ann Oncol. 2019;30(12):1925-1940. doi: 10.1093/annonc/mdz410

 

  1. American Cancer Society. Chemo Brain[EB/OL]; 2023. Available from: https://www.cancer.org/treatment/ treatments-and-side-effects/physical-side-effects/changes-in-mood-or-thinking/chemo-brain.html [Last accessed on 2025 May 29].

 

  1. And Alternative Medicine EC. Changes and influencing factors of cognitive impairment in patients with breast cancer. Evid Based Complement Alternat Med. 2023;2023:9872082. doi: 10.1155/2023/9872082

 

  1. Tyagi K, Masoom M, Majid H, et al. Role of cytokines in chemotherapy-related cognitive impairment of breast cancer patients: A systematic review. Curr Rev Clin Exp Pharmacol. 2023;18(2):110-119. doi: 10.2174/2772432817666220304212456

 

  1. Rodríguez Martín B, Fernández Rodríguez EJ, Rihuete Galve MI, Cruz Hernández JJ. Study of chemotherapy-induced cognitive impairment in women with breast cancer. Int J Environ Res Public Health. 2020;17(23):8896.doi: 10.3390/ijerph17238896

 

  1. Yao S, Zhang Q, Yao X, et al. Advances of neuroimaging in chemotherapy related cognitive impairment (CRCI) of patients with breast cancer. Breast Cancer Res Treat. 2023;201:15-26. doi: 10.1007/s10549-023-07005-y

 

  1. Regier NG, Naik AD, Mulligan EA, et al. Cancer-related cognitive impairment and associated factors in a sample of older male oral-digestive cancer survivors. Psychooncology. 2019;28(7):1551-1558. doi: 10.1002/pon.5131

 

  1. McHugh Power JE, Lawlor BA, Kee F. Social support mediates the relationships between extraversion, neuroticism, and cognitive function in older adults. Public Health. 2017;147:144-152. doi: 10.1016/j.puhe.2017.02.015

 

  1. Ibrahim EY, Domenicano I, Nyhan K, et al. Cognitive effects and depression associated with taxane-based chemotherapy in breast cancer survivors: A meta-analysis. Front Oncol. 2021;11:642382. doi: 10.3389/fonc.2021.642382

 

  1. Das A, Ranadive N, Kinra M, Nampoothiri M, Arora D, Mudgal J. An overview on chemotherapy-induced cognitive impairment and potential role of antidepressants. Curr Neuropharmacol. 2020;18(9):838-851. doi: 10.2174/1570159X18666200221113842

 

  1. Durán-Gómez N, López-Jurado CF, Nadal-Delgado M, Pérez-Civantos D, Guerrero-Martín J, Cáceres MC. Chemotherapy-related cognitive impairment in patients with breast cancer based on functional assessment and NIRS analysis. J Clin Med. 2022;11(9):2363. doi: 10.3390/jcm11092363

 

  1. Xu W, Wang K, Lian H. Linear convergence of decentralized estimation for statistical estimation using gradient method. Neurocomputing. 2024;584:127584. doi: 10.1016/j.neucom.2024.127584

 

  1. Wagner L, Sweet JJ, Butt Z, et al. Measuring patient self-reported cognitive function: Qualitative findings and initial development of the functional assessment of cancer therapy-cognitive function (FACT-Cog) instrument. J Support Oncol. 2009;7(6):W32-W39.

 

  1. Cheung YT, Si RL, Shwe M, et al. Psychometric properties and measurement equivalence of the English and Chinese versions of the functional assessment of cancer therapy-cognitive in Asian patients with breast cancer. Value Health. 2013;16(6):1001-1013. doi: 10.1016/j.jval.2013.06.013

 

  1. Cheung YT, Foo YL, Shwe M, et al. Minimal clinically important difference (MCID) for the functional assessment of cancer therapy: Cognitive function (FACT-Cog) in breast cancer patients. J Clin Epidemiol. 2014;67(7):811-820. doi: 10.1016/j.jclinepi.2014.01.010

 

  1. Xiao SY. Theoretical basis and research application of social support rating scale. J Clin Psychiatry. 1994;4(2):98-100.

 

  1. Liu JY, Li FY, Lian YL. Investigation of reliability and validity of the social support scale. J Xinjiang Med Univ. 2008;31(1):1-3.

 

  1. Boscher C, Joly F, Clarisse B, et al. Perceived cognitive impairment in breast cancer survivors and its relationships with psychological factors. Cancers (Basel). 2020;12(10):3000. doi: 10.3390/cancers12103000

 

  1. Abebe E, Tollesa T, Assefa M, et al. Cognitive functioning and its associated factors among breast cancer patients on chemotherapy at Tikur Anbessa specialized hospital, Addis Ababa Ethiopia: An institution-based comparative cross-sectional study. BMC Cancer. 2021;21(1):1052. doi: 10.1186/s12885-021-08799-0

 

  1. Gunstad J, Paul RH, Cohen RA, et al. Obesity is associated with memory deficits in young and middle-aged adults. Eat Weight Disord. 2006;11(1):e15-e19. doi: 10.1007/BF03327747

 

  1. Shefer G, Marcus Y, Stern N. Is obesity a brain disease? Neurosci Biobehav Rev. 2013;37(10 Pt 2):2489-2503. doi: 10.1016/j.neubiorev.2013.07.015

 

  1. Lamport DJ, Chadwick HK, Dye L, et al. A low glycaemic load breakfast can attenuate cognitive impairments observed in middle aged obese females with impaired glucose tolerance. Nutr Metab Cardiovasc Dis. 2014;24(10):1128-1136. doi: 10.1016/j.numecd.2014.04.015

 

  1. Kanaya AM, Barrett-Connor E, Gildengorin G, et al. Change in cognitive function by glucose tolerance status in older adults: A 4-year prospective study of the Rancho Bernardo study cohort. Arch Intern Med. 2004;164(12):1327-1333. doi: 10.1001/archinte.164.12.1327

 

  1. Awad N, Gagnon M, Messier C. The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. J Clin Exp Neuropsychol. 2004;26(8):1044-1080. doi: 10.1080/13803390490517975

 

  1. Dye L, Boyle NB, Champ CL, Lawton CL. The relationship between obesity and cognitive health and decline. Proc Nutr Soc. 2017;76(4):443-454. doi: 10.1017/S0029665117002014

 

  1. Kesler SR, Blayney DW. Neurotoxic effects of anthracycline- vs nonanthracycline-based chemotherapy on cognition in breast cancer survivors. JAMA Oncol. 2016;2(2):185-192. doi: 10.1001/jamaoncol.2015.4333

 

  1. Piccirillo JF, Hardin FM, Nicklaus J, et al. Cognitive impairment after chemotherapy related to atypical network architecture for executive control. Oncology. 2015;88(6):360-368. doi: 10.1159/000370117

 

  1. Yang Y, Sun H, Luo X, et al. Network connectivity between fear of cancer recurrence, anxiety, and depression in breast cancer patients. J Affect Disord. 2022;309:358-367. doi: 10.1016/j.jad.2022.04.125

 

  1. Bedillion MF, Ansell EB, Thomas GA. Cancer treatment effects on cognition and depression: The moderating role of physical activity. Breast. 2019;44:73-80. doi: 10.1016/j.breast.2019.01.004

 

  1. Zhou X, Zhang X, Zhong T, Zhou M, Gao L, Chen L. Prevalence and associated factors of chemotherapy-related cognitive impairment in older breast cancer survivors. J Adv Nurs. 2024;80(2):484-499. doi: 10.1111/jan.15842

 

  1. Bailey LR, Craft M, Bert SSC, Carlson BW. The impact of chemotherapy-related cognitive impairment on social roles and well-being in breast cancer survivors. Oncol Nurs Forum. 2024;51(2):153-162. doi: 10.1188/24.ONF.153-162

 

  1. Gates P, Green HJ, Gough K, et al. Web-based cognitive rehabilitation intervention for cancer-related cognitive impairment following chemotherapy for aggressive lymphoma: Protocol for a randomised pilot trial. BMJ Open. 2024;14(3):e081084. doi: 10.1136/bmjopen-2023-081084

 

  1. Tolin DF, Lord KA, Knowles KA. Cognitive-behavioral therapy enhancement strategies. Psychiatr Clin North Am. 2024;47(2):355-365. doi: 10.1016/j.psc.2024.02.005

 

  1. Cheng ASK, Wang X, Niu N, Liang M, Zeng Y. Neuropsychological interventions for cancer-related cognitive impairment: A network meta-analysis of randomized controlled trials. Neuropsychol Rev. 2022;32(4):893-905. doi: 10.1007/s11065-022-09566-z

 

  1. McDonald BC, Conroy SK, Ahles TA, West JD, Saykin AJ. Alterations in brain activation during working memory processing associated with breast cancer and treatment: A prospective functional magnetic resonance imaging study. J Clin Oncol. 2012;30(20):2500-2508. doi: 10.1200/JCO.2011.38.5674

 

  1. Von Ah D, McDonald BC, Crouch AD, et al. Randomized double-masked controlled trial of cognitive training in breast cancer survivors: A preliminary study. Support Care Cancer. 2022;30(9):7457-7467. doi: 10.1007/s00520-022-07182-4
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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